When Insurance Doesn't Cover Property Damage: One Homeowner's Experience
The Shocking Gaps in Coverage: Lessons from a Denied Fire Damage Claim
The information on this website is general in nature and does not take into account your objectives, financial situation, or needs. Consider seeking personal advice from a licensed adviser before acting on any information.
A homeowner recently learned the hard way that just because you have insurance doesn't mean you're fully covered when disaster strikes.
In this case, a homeowner's investment property was damaged in a fire - started by the homeowner's son - but the insurance company refused the claim.
The Fire and the Claim
On February 17, 2021, a property owned by a homeowner was set on fire. The homeowner submitted a claim to their insurer, Suncorp. Unfortunately, Suncorp denied the claim, citing a clause in the policy's Product Disclosure Statement (PDS) that specifically excluded coverage for malicious acts and vandalism committed by a resident of the insured address with the policyholder's consent.
In this case, the homeowner's son - who was living in the property at the time - had caused the fire and subsequently pleaded guilty.
The Policy Exclusions
The exclusion the insurer cited is a common one in insurance policies. Policies contain various exclusions that limit coverage, and it's important for policyholders to review these carefully and understand what is and isn't covered.
In this case, the exclusion applied to the son's deliberate act that demonstrated "a reckless disregard for the consequences." The fact that the homeowner didn't consent to the fire was irrelevant because the son was living at the property with the homeowner's consent.
The Insurance Claim Dispute
The homeowner argued that the exclusion shouldn't apply because they didn't consent to their son lighting the fire. However, Australian Financial Complaints Authority (AFCA) disagreed, stating that the exclusion applied to anyone living at the property with the insured's consent. The panel said that it was satisfied that the son had caused the fire and that the exclusion applied.
Notably, while the court refused to record the son's guilty plea due to concerns about his mental health, AFCA said that there was not enough information about his state of mind to overrule the insurer's decision. AFCA added that the complainant could ask Suncorp to reassess its liability once a psychiatric report was provided and the court outcome had been determined.
The Settlement Offer
Following the claim's denial, Suncorp offered the homeowner an ex-gratia payment of $261,318, which the homeowner deemed insufficient for repair costs. The homeowner sought an additional $166,159 or $261,328, based on quotes provided.
However, AFCA noted that Suncorp's offer had been based on an itemised repair quote from an assessment by the insurer's builder, which the panel deemed fair.
Conclusion
Insurance policies can be complex and challenging to navigate, especially when dealing with policy exclusions. In this case, the homeowner's insurance policy didn't cover damages caused by their son, even though the homeowner didn't consent to the fire. Understanding the specifics of your policy - including the exclusions - is critical in knowing precisely what you are and aren't covered for.
Published:Thursday, 25th May 2023 Source: Paige Estritori
Please Note: If this information affects you, seek advice from a licensed professional.
Isuzu Australia has announced the establishment of Isuzu Financial Services Australia (IFSA), a pioneering truck leasing and finance company set to commence operations in the third quarter of next year. This initiative marks the first time the Isuzu Group has founded such a company outside Japan, highlighting the strategic importance of the Australian market. - read more
The National Truck Accident Research Centre (NTARC) has released its latest Major Incident Investigation Report, shedding light on the predominant causes of significant truck crashes across Australia. The findings reveal that human factors, particularly inattention, distraction, and inappropriate speed, continue to be the leading contributors to these incidents. - read more
The Australian government has enacted legislation prohibiting life insurers from using the results of genetic tests to refuse coverage or increase premiums. This landmark decision aims to eliminate genetic discrimination and encourage individuals to undergo potentially life-saving genetic testing without fear of financial repercussions. - read more
Recent findings from the PwC Insurance Banana Skins Survey have raised concerns about the preparedness of Australian insurers in managing emerging risks, particularly those associated with cyber threats and artificial intelligence (AI). The survey, which gathered insights from 698 insurance executives across 42 territories, including 37 from Australia, indicates that Australian insurers scored 6.6% lower on the Preparedness Index compared to their global counterparts. - read more
Businesses across New South Wales are grappling with substantial increases in insurance premiums, prompting calls for urgent reforms to alleviate financial pressures. According to Business NSW's latest Business Conditions Survey, nearly 80% of businesses have experienced double-digit hikes in insurance costs over the past year, with one in three reporting increases of 30% or more. These surges significantly outpace the annual inflation rate of 2.5%, placing an undue burden on the business community. - read more
Being prepared when it comes to life insurance claims can make a world of difference. Proper preparation helps you prevent delays and denials, ensuring that your loved ones receive the financial support promised by your policy without unnecessary hold-ups. By paying attention to the details, you can streamline the claims process, giving you and your family peace of mind during what is already a stressful time. - read more
Life insurance is a cornerstone of financial planning, offering peace of mind to you and security for your loved ones. It's a contract between you and an insurance company: in exchange for regular premiums, the insurer agrees to pay a sum of money to designated beneficiaries upon your passing. This vital tool ensures that your family's financial needs can be met during an incredibly difficult time. - read more
Life insurance is a fundamental component of a robust financial plan, yet its significance is often underestimated. It serves as a safety net, ensuring that your loved ones are financially secure in the event of your absence. Understanding life insurance is the first step towards safeguarding your family’s future. - read more
Life insurance is a cornerstone of financial planning for Aussie families, offering protection and peace of mind. But what happens when the bustling flow of life brings changes? This is where a life insurance review comes into play. A life insurance review is a thorough analysis of your existing policy to ensure it aligns with your current life circumstances and financial goals. - read more
For many millennials, navigating the complexities of personal finance and future planning can feel like a bewildering journey. Among these financial responsibilities, life insurance emerges as a paramount consideration. More than just a safety net, life insurance can be the cornerstone of a sound financial strategy, providing peace of mind for both the policyholder and their loved ones. - read more
Start Here !
Apply now for your free Insurance assessment and price comparisons!
Knowledgebase
Term Life Insurance: A form of life insurance that is a pure protection policy with no cash or maturity value which lasts for a specific length of time, called a term.
